February 26, 2020 — American Journal of Roentgenology
OBJECTIVE. The contrast-enhanced ultrasound (CEUS) imaging features of hepatic vascular tumors in infants, including infantile hemangioma (IH) and congenital hemangioma (CH), are not well reported. Frequent inaccurate use of lesion terminology in the literature has created diagnostic confusion. The purpose of this study is to describe the CEUS features of IH and CH.
MATERIALS AND METHODS. Ten patients, ranging in age from 8 days to 16 months, with hepatic vascular tumors were included for retrospective analysis. Gray-scale ultrasound, color Doppler ultrasound, and CEUS features were reviewed, and interobserver kappa coefficients were calculated. Final diagnoses were clinically determined by a pediatrician with expertise in vascular anomalies except in one patient who underwent surgical excision.
RESULTS. Of the 10 patients, five had CHs and five had IHs. All 10 lesions were hyperenhancing in the early arterial phase. In the portal venous phase, four of five (80%) CHs showed hyperenhancement relative to normal liver parenchyma, whereas four of five (80%) IHs showed isoenhancement. In the late phase, washout of contrast material was seen in three of five (60%) IHs, whereas one IH remained isoenhancing and one IH was hyperenhancing. None of the CHs showed late washout. Interobserver kappa coefficients for CEUS features ranged from 0.60 to 1.00.
CONCLUSION. Except for the CEUS feature portal venous phase enhancement (κ = 0.60), good to excellent (κ = 0.74–1.00) agreement about CEUS features of IHs and CHs was observed. A significant proportion of IHs (60%) showed washout at delayed phase imaging, which has also been reported with malignancies. Recognition of the overlap in imaging appearance of these two entities is vital to preventing misdiagnosis of malignancy.
Authors: Alexander Maad El-Ali1, Andrew McCormick2,3, Darshit Thakrar4,5, Sabri Yilmaz3,4,5 ,5, Marcus M. Malek3,6 and Judy H. Squires4,5
1Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA.; 2Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA.; 3Vascular Anomalies Center, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA.; 4Department of Pediatric Radiology, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave, 2nd Fl Radiology, Pittsburgh, PA 15224.; 5Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA.; 6Department of Pediatric General and Thoracic Surgery, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA.